Do It With Intent!

It is easy to treat an acute derangement with no deformity or acutely locked facet that may need some repeated motions and/or a thrust manipulation. You explain their condition, give them their options, educate them, and treat them.

What about difficult patients? What about the patients who have had pain for years, who don't have a directional preference, when everything is too tender to touch, or they drop the "f" bomb during the subjective many times? (I'm not talking about the curse word either)

Do you treat them as if they were the acute, uncomplicated, neck or back patient, or ankle sprain? Are you as confident you can help them? Do you spend as much time with them? Do you explain their condition to them to help desensitize their central nervous system, which perceives everything as a threat? If not, you should! We all have patients on our schedule that makes our stomach drop like we were on a roller coaster. Those are the patients you should try the hardest with! Kill them with kindness! Tell them no pain lasts forever, treat them, and get them moving! They can sense if you are phoning it in. Intend to make them better.

I saw a patient I'll never forget twice during my career. Once at the beginning, when after graduating from a great PT school, and then finishing my MTC within 1 year, I thought I could handle it all. He was a kind, older gentleman who had chronic headaches. Nothing I tried made him better, but he was very grateful that I tried. Four years later, I had some NOI, Mulligan, IPA, MDT, and Rocabado under my belt. His neurologist sent him back to me. I told him I had learned a few new tricks and was confident he would get better. It presented as mechanical, but nothing I did made him better. Again, he was grateful that I tried, and even gave me a pat on the back for doing so.

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